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        <BusinessName>
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          <StateAbbreviationCd>PA</StateAbbreviationCd>
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        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
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        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
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        <TakeIntoAccountOthersInputInd>1</TakeIntoAccountOthersInputInd>
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        <RptAvailableOnOwnWebsiteInd>X</RptAvailableOnOwnWebsiteInd>
        <OwnWebsiteURLTxt>HTTPS://CORRYHOSPITAL.COM/ABOUT/</OwnWebsiteURLTxt>
        <PaperCopyPublicInspectionInd>X</PaperCopyPublicInspectionInd>
        <ImplementationStrategyAdoptInd>1</ImplementationStrategyAdoptInd>
        <ImplementationStrategyAdptYr>21</ImplementationStrategyAdptYr>
        <StrategyPostedWebsiteInd>1</StrategyPostedWebsiteInd>
        <StrategyWebsiteURLTxt>HTTPS://CORRYHOSPITAL.COM/ABOUT/</StrategyWebsiteURLTxt>
        <OrganizationIncurExciseTaxInd>0</OrganizationIncurExciseTaxInd>
        <EligCriteriaExplainedInd>1</EligCriteriaExplainedInd>
        <FPGFamilyIncmLmtFreeDscntInd>X</FPGFamilyIncmLmtFreeDscntInd>
        <FPGFamilyIncmLmtFreeCarePct>150.000000000000</FPGFamilyIncmLmtFreeCarePct>
        <FPGFamilyIncmLmtDscntCarePct>300.000000000000</FPGFamilyIncmLmtDscntCarePct>
        <IncomeLevelCriteriaInd>X</IncomeLevelCriteriaInd>
        <AssetLevelCriteriaInd>X</AssetLevelCriteriaInd>
        <MedicalIndigencyCriteriaInd>X</MedicalIndigencyCriteriaInd>
        <InsuranceStatusCriteriaInd>X</InsuranceStatusCriteriaInd>
        <UnderinsuranceStatCriteriaInd>X</UnderinsuranceStatCriteriaInd>
        <ResidencyCriteriaInd>X</ResidencyCriteriaInd>
        <ExplainedBasisInd>1</ExplainedBasisInd>
        <AppFinancialAsstExplnInd>1</AppFinancialAsstExplnInd>
        <DescribedInfoInd>X</DescribedInfoInd>
        <DescribedSuprtDocInd>X</DescribedSuprtDocInd>
        <ProvidedHospitalContactInd>X</ProvidedHospitalContactInd>
        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
        <IncludesPublicityMeasuresInd>1</IncludesPublicityMeasuresInd>
        <FAPAvailableOnWebsiteInd>X</FAPAvailableOnWebsiteInd>
        <FAPAvailableOnWebsiteURLTxt>LECOMHEALTH.COM/COMMUNITY-HOSPITAL/PATIENT-SERVICES/</FAPAvailableOnWebsiteURLTxt>
        <FAPAppAvailableOnWebsiteInd>X</FAPAppAvailableOnWebsiteInd>
        <FAPAppAvailableOnWebsiteURLTxt>LECOMHEALTH.COM/COMMUNITY-HOSPITAL/PATIENT-SERVICES/</FAPAppAvailableOnWebsiteURLTxt>
        <FAPSummaryOnWebsiteInd>X</FAPSummaryOnWebsiteInd>
        <FAPSummaryOnWebsiteURLTxt>LECOMHEALTH.COM/COMMUNITY-HOSPITAL/PATIENT-SERVICES/</FAPSummaryOnWebsiteURLTxt>
        <FAPAvlblOnRequestNoChargeInd>X</FAPAvlblOnRequestNoChargeInd>
        <FAPAppAvlblOnRequestNoChrgInd>X</FAPAppAvlblOnRequestNoChrgInd>
        <FAPSumAvlblOnRequestNoChrgInd>X</FAPSumAvlblOnRequestNoChrgInd>
        <NotifiedFAPCopyBillDisplayInd>X</NotifiedFAPCopyBillDisplayInd>
        <OtherPublicityInd>X</OtherPublicityInd>
        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
        <PermitNoActionsInd>X</PermitNoActionsInd>
        <CollectionActivitiesInd>0</CollectionActivitiesInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
        <ProcessedFAPApplicationInd>X</ProcessedFAPApplicationInd>
        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
        <LookBackMedicaidMedcrPrvtInd>X</LookBackMedicaidMedcrPrvtInd>
        <AmountsGenerallyBilledInd>0</AmountsGenerallyBilledInd>
        <GrossChargesInd>0</GrossChargesInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CORRY MEMORIAL HOSPITAL ASSOCIATION</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 5: DATA COMES FROM MULTIPLE SOURCES INCLUDING RESIDENTS LIVING IN THE COUNTY, CORRY, AND SURROUNDING AREA OF ERIE COUNTY. THE CORRY MEMORIAL HOSPITAL CHNA WAS DEVELOPED FROM DATA OBTAINED FROM DATA FROM THE BLUE ZONES CORRY PROJECT. THE BLUE ZONES CORRY PROJECT DATA WAS SPECIFICALLY ON THE CORRY AREA RESIDENTS. THERE WERE MULTIPLE SURVEYS THROUGHOUT THE 3-YEAR PROJECT THROUGH MAY 2022.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CORRY MEMORIAL HOSPITAL ASSOCIATION</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 11: CORRY MEMORIAL HOSPITAL DEVELOPED AN IMPLEMENTATION PLAN TO ADDRESS THE SIGNIFICANT NEEDS IDENTIFIED THROUGH ITS CHNA. AS WITH MOST HEATH CARE FACILITIES, CORRY MEMORIAL HOSPITAL HAS LIMITED FINANCIAL RESOURCES TO ADDRESS ALL ISSUES IDENTIFIED IN THE CHNA.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>CORRY MEMORIAL HOSPITAL ASSOCIATION</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS ALSO POSTED IN LOCAL PHYSICIAN OFFICES.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LN 7 COL(F):</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BAD DEBT EXPENSE OF 827,824 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL ASSOCIATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. THE BAD DEBT EXPENSE CONSISTS OF BALANCES THAT ARE SENT TO COLLECTIONS AS WELL AN ADDITIONAL AMOUNT ASSESSED BY MANAGEMENT. EVERY MONTH MANAGEMENT REVIEWS THE ACCOUNTS RECEIVABLE BALANCE AND WRITES OFF ADDITIONAL AMOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL COLLECTIONS AND ECONOMIC CONDITIONS.A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL. IF CORRY MEMORIAL HOSPITAL CEASED TO EXIST PATIENTS WOULD HAVE TO TRAVEL A MINIMUM OF 26 MILES TO NEAREST HOSPITAL WHICH WOULD CREATE A HARDSHIP FOR MANY. A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 9B:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE HOSPITAL DOES NOT ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS BEFORE MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>DURING FISCAL YEAR 2016, CORRY MEMORIAL HOSPITAL ASSOCATION CONDUCTED A COUNTY-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THIS STUDY WAS CONDUCTED TO: (1) PROVIDE A COMPREHENSIVE OVERVIEW OF THE HEALTH STATUS OF ERIE COUNTY, (2) IDENTIFY PRIORITY HEALTH NEEDS WITHIN THE COUNTY, (3) ORGANIZE THESE PRIORITIES INTO STRATEGIC ISSUES, AND (4) SHARE THIS INFORMATION WITH THE COMMUNITY AT LARGE, INCLUDING STAKEHOLDERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>IF A PERSON IS ADMITTED WITH NO INSURANCE THEY ARE VISITED BY A FINANCIAL AID COUNSELOR AND MADE AWARE OF ASSISTANCE OPTIONS. ALL SELF-PAY PATIENTS ARE MAILED A LETTER THAT DESCRIBES THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND HOW TO APPLY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN CORRY PENNSYLVANIA. THE HOSPITAL SERVES THE RESIDENTS OF NORTHWESTERN PENNSYLVANIA AND SOUTHWESTERN NEW YORK. CORRY PENNSYLVANIA IS A RURAL TOWN WITH A POPULATION OF APPROXIMATELY 6,300. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IS $30,474 WHICH IS WELL BELOW THE PENNSYLVANIA AVERAGE OF $49,520. APPROXIMATELY 25% OF RESIDENTS IN CORRY PENNSYLVANIA LIVE IN POVERTY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. FROM DIABETES EDUCATION TO OCCUPATIONAL HEALTH SERVICES AND MORE, WE WANT TO ENSURE THAT EACH AND EVERY MEMBER OF OUR COMMUNITY RECEIVES THE BEST CARE AVAILABLE NOT FOR THE MONEY, NOT FOR THE ACCOLADES, BUT FOR THE HEALTH AND WELL-BEING OF OUR NEIGHBORS, OUR FRIENDS AND OUR FAMILIES. CORRY MEMORIAL HOSPITAL HAS BEEN ABLE TO PROVIDE "STATE OF THE ART" MEDICAL FACILITIES FOR THE PAST ONE HUNDRED YEARS BECAUSE OF THE EFFORTS OF THE BOARD OF TRUSTEES, THE DOCTORS, NURSES AND EMPLOYEES. THE BOARD OF TRUSTEES IS MADE UP OF INDIVIDUALS WHO LIVE AND WORK IN THE COMMUNITY WHO VOLUNTEER THEIR TIME AND SERVICES TO ASSIST IN THE GOVERNANCE OF THE ORGANIZATION. CORRY MEMORIAL HOSPITAL EXTENDS MEDICAL PRIVILEGES TO QUALIFIED PHYSICIANS SUBJECT TO THE NORMAL APPLICATION PROCESS WHICH MUST BE APPROVED BY THE CREDENTIALS COMMITTEE, THE MEDICAL EXECUTIVE COMMITTEE AND THE BOARD OF TRUSTEES. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER OF CORRY MEMORIAL HOSPITAL IS MILLCREEK HEALTH SYSTEM D/B/A LECOM HEALTH SYSTEM, A PENNSYLVANIA NONPROFIT CORPORATION.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER, MILLCREEK HEALTH SYSTEM HAS THE RIGHT TO APPOINT OR REMOVE BOARD MEMBERS. THE BOARD SHALL CONSIST OF SEVEN (7) MEMBERS. THREE BOARD MEMBERS SHALL BE NAMED BY THE MEMBER AND FOUR BY THE PRIOR BOARD OF CORRY.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOLLOWING POWERS, RIGHTS, AND PRIVILEGES ARE EXPRESSLY RESERVED BY THE MEMBER: (1) THE RIGHT TO ALTER, AMEND OR REPEAL THE ARTICLES OF INCORPORATION OF CORRY; (2) THE RIGHT TO APPROVE ANY AND ALL TRANSACTIONS THAT CHANGE, OR HAVE THE EFFECT OF CHANGING, THE OWNERSHIP AND/OR CONTROL OF CORRY. SUCH A TRANSACTION SHALL INCLUDE, BUT NOT BE LIMITED TO, ANY PROPOSED ATTEMPT TO MERGE, ACQUIRE OR COMBINE CORRY WITH ANY OTHER FACILITY, SYSTEM, AFFILIATE, ENTITY OR PERSON, WHETHER SUCH TRANSACTION IS BY CONTRACT, SALE OF ALL OR SUBSTANTIALLY ALL OF ITS ASSETS OR BY OPERATION OF LAW; (3) THE RIGHT TO APPOINT OR REMOVE BOARD MEMBERS OF CORRY; (4) THE RIGHT TO APPROVE THE BUDGET AND ALL PROPOSED CAPITAL EXPENDITURES OF CORRY.</ExplanationTxt>
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        <ExplanationTxt>CORRY MEMORIAL HOSPITAL ASSOCIATION HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. A COPY OF THE 990 IS PROVIDED TO THE BOARD OF TRUSTEES BEFORE IT IS FILED.</ExplanationTxt>
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      <SupplementalInformationDetail>
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        <ExplanationTxt>EACH OFFICER, TRUSTEE AND KEY EMPLOYEE IS REQUIRED TO FILL OUT AN ANNUAL CONFLICT OF INTEREST FORM. THE FORMS ARE REVIEWED INITIALLY BY THE CEO. ANY CONFLICTS ARE REVIEWED BY BOARD MEMBERS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS.</ExplanationTxt>
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      <SupplementalInformationDetail>
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        <ExplanationTxt>CORRY MEMORIAL HOSPITAL ASSOCIATION'S EXECUTIVE COMMITTEE APPROVES COMPENSATION FOR ALL OFFICERS AND KEY EMPLOYEES. MEMBERS OF MANAGEMENT MAKE RECOMMENDATIONS TO THE HR COMMITTEE. THE HR COMMITTEE THEN MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE, WHICH HAS FINAL APPROVAL. PERIODIC REVIEW OF REGIONAL COMPARABLE SALARIES IS TAKEN INTO CONSIDERATION.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 18</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL ASSOCIATION MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>CORRY MEMORIAL HOSPITAL ASSOCIATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN INTEREST IN ASSETS HELD BY CORRY COMMUNITY FOUNDATION 93,341. TRANSFER TO AFFILIATES 177,223.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S BOARD OF TRUSTEES ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED.</ExplanationTxt>
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        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 13</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S EMPLOYEE HANDBOOK STATES EMPLOYEES SHALL BE ALLOWED TO VOICE AN UNJUST SITUATION WITHOUT FEAR OF RECRIMINATION.</ExplanationTxt>
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        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 16B</FormAndLineReferenceDesc>
        <ExplanationTxt>WHEN CORRY MEMORIAL HOSPITAL ASSOCIATION CONTEMPLATES ENTERING INTO A JOINT VENTURE WITH FOR PROFIT ORGANIZATIONS, IT ENGAGES LEGAL COUNSEL AND TAX COUNSEL TO ENSURE THAT THE TAX EXEMPT STATUS OF THE HEALTH CENTER IS SAFEGUARDED.</ExplanationTxt>
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          <BusinessNameLine1Txt>ACHIEVEMENT CENTER INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>4950 WEST 23RD STREET SUITE 1</AddressLine1Txt>
          <CityNm>ERIE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16506</ZIPCd>
        </USAddress>
        <EIN>250965336</EIN>
        <PrimaryActivitiesTxt>THERAPEUTIC SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>MILLCREEK HEALTH SYSTEM</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>COUNSELING SERVICES CENTER INC DBA CORRY COUNSELING SERVICES</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>45 EAST WASHINGTON STREET</AddressLine1Txt>
          <CityNm>CORRY</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16407</ZIPCd>
        </USAddress>
        <EIN>251323591</EIN>
        <PrimaryActivitiesTxt>MENTAL HEALTH SERVICES</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>MILLCREEK HEALTH SYSTEM</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>LECOM HEALTH RISK RETENTION GROUP</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1858 W GRANDVIEW BLVD</AddressLine1Txt>
          <CityNm>ERIE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16509</ZIPCd>
        </USAddress>
        <EIN>854350386</EIN>
        <PrimaryActivitiesTxt>LIABILITY INSURANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 12A, I</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>MILLCREEK HEALTH SYSTEM</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>CORRY HEALTH SERVICES INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>965 SHAMROCK LANE</AddressLine1Txt>
          <CityNm>CORRY</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16407</ZIPCd>
        </USAddress>
        <EIN>251488214</EIN>
        <PrimaryActivitiesTxt>HEALTH CARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>CORRY MEMORIAL HOSPITAL ASSOCIATION</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ShareOfTotalIncomeAmt>66968</ShareOfTotalIncomeAmt>
        <ShareOfEOYAssetsAmt>1498516</ShareOfEOYAssetsAmt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>MCH CORPORATION</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>5515 PEACH STREET</AddressLine1Txt>
          <CityNm>ERIE</CityNm>
          <StateAbbreviationCd>PA</StateAbbreviationCd>
          <ZIPCd>16509</ZIPCd>
        </USAddress>
        <EIN>251549695</EIN>
        <PrimaryActivitiesTxt>REAL ESTATE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>1</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>0</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
